How To Choose A Prenatal Vitamin

What prenatal vitamin should I take?  I get this question a lot, and for good reason – it’s an important one!

prenatal vitamins

 

If you’re pregnant, or planning to become pregnant in the near future, choosing an appropriate prenatal vitamin is a smart decision.  I’ve seen many woman (myself included), pick up the first prenatal vitamin they see off the shelves, without giving much thought to the list of nutrients, or the structural form of the vitamin.

In this post, I’ll teach out how to:

  1. Purchase supplements from a reputable manufacturer.
  2. Purchase supplements that have been 3rd party tested.
  3. Check supplement labels for key prenatal nutrients.

prenatal vitamin

1. Purchase supplements from a reputable manufacturer.

I’d love to say that we can trust any supplement to deliver what it says it will, in a chemical form that’s best suited for one’s body, but I can’t.

While supplements are regulated by the Food & Drug Administration (FDA), they don’t follow the same strict process as food & drugs.  Instead, supplement companies are responsible for evaluating the safety and labeling of their own products before marketing to ensure their products meet requirements under the Dietary Supplement Health and Education Act (DSHEA).  Manufacturers must also follow good manufacturing practices (GMPs) established by the FDA to ensure that their supplements are processed consistently and meet quality standards.

The FDA is only responsible for monitoring and taking action against any adulterated or misbranded dietary supplement products once it’s already on the market.  Since this is the case, it’s important to purchase supplements from a reputable manufacturer who abides by FDA regulations and takes appropriate action towards product quality.

 

How do you know if your supplement comes from a reputable manufacturer?

When looking for a trustworthy manufacturer/product, ask a few questions:

• Has the supplement been tested for the absence of harmful levels of known or potential contaminants? BONUS if the product provides a third-party seal of approval on the package? (e.g. USP, NSF etc.).  More on this below…
• Was the supplement produced at a facility that meets industry standards for GMPs?
• Does the supplement’s label make claims that seem too good to be true?

You may need to head to the manufacturers website to get a few of these questions answered, and don’t hesitate to contact the manufacturer directly!

2. Purchase supplements that have been 3rd party tested.

Several independent organizations offer testing of product quality to help assure the product was properly manufactured, contains the ingredients listed on the label in the declared dose, and does not contain harmful levels of contaminants.  Products that pass these quality tests are then allowed to display the “3rd party’s seal of approval”.

Organizations that offer this quality testing include:

  • U.S. Pharmacopeia (USP)
  • ConsumerLab.com
  • NSF International

 

As mentioned above, supplement companies are responsible for having evidence that their products are safe and any label claims are truthful and not misleading. BUT, manufacturers do not have to provide that evidence to the FDA before the product is marketed.   This is why I feel it’s important to have a “3rd party seal” listed on the label, as it strengthens my trust of the manufacturer.

As a future mama, it’s important to source your prenatal vitamin from a reputable manufacturer.

prenatal vitamin

3. Check the label for key nutrients during the prenatal period (& vitamin forms).

Now that you know a bit about supplement regulation and how to look for a reputable manufacturer, let’s move on to what to look for in a prenatal vitamin.

Not all prenatal vitamins are the same.  Many prenatal vitamins contain different nutrients, different doses, & even different structural forms of key nutrients, making it challenging to know what to look for.  Through my research, I’ve found there is no ONE perfect supplement, and that you may need to supplement with more than one vitamin, or be okay with a slightly “less than perfect” prenatal vitamin.

If you don’t find the perfect one, rest assured…  Supplements are just that, SUPPLEMENTS to your diet. They are not meant to replace healthy eating, and they certainly cannot guarantee any health benefits.  I recommend first focusing on a nutritious, well-balanced diet, and using supplements to fill in any gaps.  Make sure to grab your FREE Nourished Mom’s Guide for tips on meal planning & prep!

healthy mom nutrition

Key prenatal nutrients to look for:

Choline.

Choline is an essential B-vitamin that plays important roles in gene expression, cell signaling, fat metabolism, and early brain development.

The recommended dietary intake of choline for females 19 years+ is 425 mg/day. That number jumps to 450 mg/day for pregnant women and 550 mg/day when breastfeeding.

Food sources of choline include: eggs, chicken, and fish.  Some vegetables, certain beans, and other plant foods like nuts, seeds and whole grains also contain small amounts of choline. Read more on the amount of choline in specific foods.

Sadly, most Americans consume less than the recommended intake for choline, and approximately 90%–95% of pregnant women consume less choline than the adequate intake. That’s almost ALL of us….eek!! 

Unfortunately, many prenatal supplements DO NOT contain choline. If they do, it’s typically in very small amounts. Make sure to check the labels of your prenatal vitamin & seek one that has choline.  If not, consider adding a choline supplement, especially if you are vegetarian/vegan.

–> When selecting a prenatal, look for one with at least 50 mg of choline.

 

Folate/Folic Acid.

Folate is a vitamin used to make DNA and other genetic material. Folate also plays a role in nervous system function, and may be best known for its role in preventing neural tube defects in newborns.

For women 19+ years, the recommended daily allowance for folate jumps from 400 mcg dietary folate equivalents (DFE) to 600 mcg DFE during pregnancy, and 500 mcg DFE during breastfeeding.  (Side note: 1 mcg DFE = 0.6 mcg folic acid from fortified foods or dietary supplements consumed with foods).

Food sources of folate include: vegetables, fruit, nuts, beans, seafood, eggs, dairy, meat, chicken & some grains.  In 1998, the FDA required manufacturers to add folic acid (the synthetic for of folate) to enriched breads, cereals, flours, pastas, rice, and other grain products to reduce the risk of neural tube defects in unborn babies (caused by folate deficiency). Read more on the amount of folate/folic acid in specific foods.

Although most Americans consume adequate amounts of folate through food, certain populations, including woman of childbearing age, are at risk of inadequate folate intakes, which is why supplementation (e.g. prenatal vitamins) if often recommended.

Furthermore, there is some debate & emerging research on which “form” of folate is best.  Both naturally occurring folate and folic acid need to become “metabolically active” in the body to provide proper function.  The active form of folate, 5-methyltetrahydrofolate (5-MTHF), requires the enzyme methylenetetrahydrofolate reductase (MTHFR).  Individuals with a MTHFR genetic polymorphism, have reduced capacity to “activate” folate, and therefore direct supplementation with the active form, 5-MTHF, may be beneficial in this population (research is still ongoing).

–> When selecting a prenatal, look for one with 600 mcg DFE (or ~360 mcg folic acid).  Most will contain more than this amount…a topic for another day 🙂

 

Iron.

Iron is an essential component of the hemoglobin protein in red blood cells that help transfer oxygen to tissue & muscle.  Iron is also necessary for growth, cell functioning, and some hormones & connective tissues.

The recommended Dietary Allowance for iron jumps from 18 mg/day to 27 mg/day in women 19-50 years, and down to 9 mg/day during postpartum & breastfeeding (if no menstrual period).

Iron is found in both plant and animal foods, with the most bioavailable form (heme iron) in animal products like meat and seafood.  Plant sources of iron (non-heme iron) are found in nuts, beans, vegetables and fortified grain products.  Plant sources are less bioavailable.  Consuming plants sources with vitamin C foods like citrus fruit, broccoli or tomatoes can help enhance non-heme iron absorption. Read more on the amount of iron in specific foods.

Most Americans consume enough iron from their diets, but pregnant women are at risk of obtaining insufficient amounts.  This is because during pregnancy, blood volume increases, and as a result women’s iron needs increase. Iron deficiency during pregnancy increases the risk of maternal and infant death, premature birth, and low birthweight.

Most prenatal vitamins contain 27 mg of iron (100% of the daily value for pregnant women).  However, some prenatal vitamins do not contain iron. One reason being that high doses of supplemental iron (45 mg/day+) may cause side effects like nausea or constipation.  If you struggle with nausea or constipation, work with your doctor to identify another form of iron that you can take.  Some forms of iron (e.g iron bisglycinate, or iron chelates) appear to be more gentle on the stomach (see study).

You’ll be screened for iron deficiency at a doctors visit during your pregnancy, but if you have a history of anemia, or if you are vegetarian or vegan, work with your doctor on a proper supplementation routine.

–> When selecting a prenatal, look for one with 27 mg of iron (preferably in a glycinate or chelated form if you struggle with nausea or constipation).

 

Iodine.

Iodine is a trace element naturally present in some foods, and added to others.  Iodine is an essential component of thyroid hormones which regulate many important biochemical reactions, including metabolism.  Thyroid hormones are also required for proper skeletal and central nervous system development in fetuses and infants.

For women 19+ years, the recommended daily allowance for iodine jumps from 150 mcg to 220 mcg during pregnancy, and 290 mcg during breastfeeding.

Food sources of iodine include: seaweed, seafood, dairy products, eggs and iodized salt.  Read more on iodine levels in certain foods here.

Most Americans get enough iodine, but some pregnant women may be at risk for iodine deficiency due to higher requirements.

–> When selecting a prenatal, look for one with 150 mcg of iodine.

 

Docosahexaenoic acid (DHA). 

DHA is a type of essential omega-3 fat that plays a role in the structure of cell membranes. DHA plays a vital role in eye and brain healthy and is critical during pregnancy and infancy.

Women are advised to supplement with 200 mg of DHA/day during pregnancy, and 300 mg when breastfeeding.

Food sources of DHA include: algae, fish, and small amounts in some eggs and grass-fed beef.  Plant sources include nuts and seeds, but they have lower bioavailability.

Since DHA is so important during pregnancy and breastfeeding, eating 8 to 12 ounces per week of fish and other marine food is recommended.  However, because fish are often contaminated with mercury, dioxins and other pollutants, many people choose to supplement with DHA/omega 3’s.  The choice is yours!

–> When selecting a prenatal, look for one with at least 200 mg of DHA (or choose to supplement separately from your prenatal as not all prenatal vitamins contain DHA).

Now, let’s take a look at a few prenatal vitamins.

As you choose a prenatal that is right for you, make sure you ask yourself a few questions. How many supplements a day do you want to take? Do you have the MTFHR gene mutation?  Are you nauseous or constipated?  Do you have low iron stores? Do you eat fish or algae weekly?

Once you identify your unique needs and do some homework on various prenatal vitamins and other supplements, work directly with your doctor to choose a supplement that is right for YOU!

Here, I quickly lay out the Pros & Cons to a few different brands.

Nature’s Made

Pros:

+ Contains folic acid, iodine, iron and DHA (so less pills to take)!

-The manufacturer follows GMP procedures, conducts third party testing (USP), and has performed absorption testing for folic acid & iron.

Cons:

-Does not contain the active form of folic acid (-methylfolate)

-Contains iron fumarate (may be problmatic for those with nausea or constipation. However, for most woman it’s not an issue).

-Does not contain choline.

 

Rainbow Prenatal One

Pros:

+ Contains the active form of folate

+ Contains iodine

+ Contain a chelated form of iron (potentially less gastrointestinal side effects)

– Manufacturer follows GMP procedures

– Formulas are tailored for each trimester (preconception, 1st, 2nd, 3rd & postnatal)

Cons:

– Does not contain choline or DHA

– Unable to find if the company conducts third party testing (e.g. USP), or has performed absorption testing for folic acid & iron (e-mail pending…)

-Contains additional ingredients like digestive blends, tummy soothe etc., which I’m not convinced will add any benefits at the dosages included (or could potentially interact with the other vitamins?)  I believe more studies need to be done on this.

 

SmartyPants Prenatal Gummy

Pros:

+ Contains the active form of folate

+ Contains iodine

+ Contain DHA & a small amount of choline

– Manufacturer follows GMP procedures & conducts 3rd party testing

Cons:

– Does not contain iron

– Contains 7 g of sugar

-Has not completed absorption testing (to my knowledge), which I would expect a Gummy vitamin to do (some preliminary thoughts/concerns with the nutrients from gummies being absorbed)

 

Additional, stand alone supplements to consider:

 

As you can see, there is no one “perfect prenatal.”  Do your homework and work with your doctor to identify the best choice for YOU.

The content in this post should NOT be considered medical advice.  People with concerns about their nutrition should speak with a healthcare professional.

*This post contains links to Amazon.com. As an Amazon Associate I earn from qualifying purchases.

 

References:

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  1. Jessi

    June 9th, 2019 at 1:08 pm

    This is a great summary Marissa! I’ve just been taking the free prenatal from my pharmacy through a doctor script, but now I want to see a list of everything in it! Had not thought about it this way, thank you!

  2. Marissa McCormick

    June 15th, 2019 at 1:30 am

    You’re so welcome! Definitely check in with your doc & look at the full list 🙂 Helps to be your own advocate!

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